Organization
LARK REXALL DRUGS INC
Active
Organization
LARK REXALL DRUGS INC
Active
Other names
LARK DRUGS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMALIA NICOLA PHARMACY TECH (PRESIDENT/OWNER)
(707) 869-9055
Entity
Organization
Contact information
Practice address
16251 MAIN ST, GUERNEVILLE, CA 95446-8300
(707) 869-9055
(707) 869-9203
Mailing address
16251 MAIN ST, GUERNEVILLE, CA 95446-8300
(707) 869-9055
(707) 869-9203
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY 51871
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY 51871
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135347
MEDICARE (IMMUNIZATIONS)
CA
01
—
1750484820
MEDI-CAL PROVIDER NUMNER
CA
01
—
PHY 51871
CALIFORNIA STATE BOARD OF PHARMACY LICENSE
CA
Enumeration date
09/06/2006
Last updated
03/25/2015
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